The BBC has a horrifying new report on the forced sterilization of women in Uzbekistan.

Stories have been leaking out for years about doctors secretly performing hysterectomies on women who have given birth in hospitals. The surgeries are described as “voluntary,” but EurasiaNet.org has reported how increasing numbers of women are choosing to give birth at home, fearing doctors will tie up their fallopian tubes or cut out their uteri without their consent.

“Every year we are presented with a plan. Every doctor is told how many women we are expected to give contraception to; how many women are to be sterilized,” a gynecologist from Tashkent told the BBC’s Natalia Antelava.

Several doctors I spoke to say that in the last two years there has been a dramatic increase in Caesarean sections, which provide surgeons with an easy opportunity to sterilize the mother. These doctors dispute official statements that only 6.8% of women give birth through C-sections.

“Rules on Caesareans used to be very strict, but now I believe 80% of women give birth through C-sections. This makes it very easy to perform a sterilization and tie the fallopian tubes,” says a chief surgeon at a hospital near the capital, Tashkent.

One local expert estimated tens of thousands of forced sterilizations have happened in the past few years across Central Asia’s most populous nation, a vast country of, officially, 28 million.

Adolat comes from Uzbekistan, where life centers around children and a big family is the definition of personal success. Adolat thinks of herself as a failure.

“What am I after what happened to me?” she says as her hand strokes her daughter’s hair – the girl whose birth changed Adolat’s life.

“I always dreamed of having four – two daughters and two sons – but after my second daughter I couldn’t get pregnant,” she says.

She went to see a doctor and found out that she had been sterilized after giving birth to her daughter by Caesarean section.

“I was shocked. I cried and asked: ‘But why? How could they do this?’ The doctor said, ‘That’s the law in Uzbekistan.'”

One mother of three describes regular visits from a nurse warning her to get a free hysterectomy before the state starts charging. “Another mother says she experienced months of mysterious pain and heavy bleeding following the birth of her son. Then she had an ultrasound check and discovered that her uterus had been removed,” the report said.

Why? Some observers believe Tashkent is obsessed with statistics. Unhappy that maternal mortality rates place the country between Palestine and Botswana (Central Asians dread being compared to Africans), officials seem to see sterilizations as a way to improve their rankings.

“It’s a simple formula – less women give birth, less of them die,” said one surgeon.

The result is that this helps the country to improve its ranking in international league tables for maternal and infant mortality.